Provider Demographics
NPI:1952766917
Name:THOMPSON, KIMBERLY (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 OLD BONHOMME RD
Mailing Address - Street 2:APT B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3932
Mailing Address - Country:US
Mailing Address - Phone:314-743-7107
Mailing Address - Fax:
Practice Address - Street 1:11648 GRAVOIS RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3034
Practice Address - Country:US
Practice Address - Phone:314-472-3411
Practice Address - Fax:314-200-6978
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015014884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional